Encounter

An interaction between a patient and healthcare provider(s) for the purpose of providing healthcare service(s) or assessing the health status of a patient.

Overview

A patient encounter is further characterized by the setting in which it takes place. An Encounter encompasses the lifecycle from pre-admission, the actual encounter (for ambulatory encounters), and admission, stay and discharge (for inpatient encounters). During the encounter the patient may move from practitioner to practitioner and location to location.

This profile is used to define the content that will be returned by the API Server in response to requests to access Encounter resources. All elements described in the Definition and Detailed Definitions below are supported, which means that the API Server is capable of supplying these fields from the product database when they have been populated via the product or its APIs.

This resource is referenced by: Condition, DiagnosticReport, DocumentReference, Immunization, MedicationRequest, Observation, Procedure.

List of profiles we support:

Definition

The official URL for this profile is:

https://fhir.athena.io/StructureDefinition/ah-encounter

The base definition for this profile is:

Encounter

Download Structure Definition
NameFlagsCard.TypeDescription & Constraintsdoco
.. Encounter0..*EncounterAn interaction during which services are provided to the patient
... idΣ0..1stringLogical id of this artifact
... metaΣ0..1MetaMetadata about the resource
... implicitRules?!Σ0..1uriA set of rules under which this content was created
... text0..1NarrativeText summary of the resource, for human interpretation
... contained0..*ResourceContained, inline Resources
... Slices for extension1..*ExtensionExtension
Slice: Unordered, Open by value:url
... ahChartSharingGroup0..1Reference(Organization)athenahealth Chart Sharing Group
URL: https://fhir.athena.io/StructureDefinition/ah-chart-sharing-group
... ahPractice1..1Reference(Organization)athenahealth Practice
URL: https://fhir.athena.io/StructureDefinition/ah-practice
... modifierExtension?!0..*ExtensionExtensions that cannot be ignored
... identifierΣ0..*IdentifierIdentifier(s) by which this encounter is known
... status?!Σ1..1codeplanned | arrived | triaged | in-progress | onleave | finished | cancelled +
Binding: EncounterStatus (required): Current state of the encounter.

... classΣ1..1CodingClassification of patient encounter
Binding: ActEncounterCode (extensible): Classification of the encounter.

... typeΣ0..*CodeableConceptSpecific type of encounter
Binding: EncounterType (example): The type of encounter.


... subjectΣ0..1Reference(Patient)The patient present at the encounter
... participantΣ0..*BackboneElementList of participants involved in the encounter
.... id0..1stringUnique id for inter-element referencing
.... extension0..*ExtensionAdditional content defined by implementations
.... modifierExtension?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... typeΣ0..*CodeableConceptRole of participant in encounter
Binding: ParticipantType (extensible): Role of participant in encounter.


.... period0..1PeriodPeriod of time during the encounter that the participant participated
.... individualΣ0..1Reference(Practitioner)Persons involved in the encounter other than the patient
... period0..1PeriodThe start and end time of the encounter
... reasonCodeΣ0..*CodeableConceptCoded reason the encounter takes place
Binding: EncounterReasonCodes (preferred): Reason why the encounter takes place.


... hospitalization0..1BackboneElementDetails about the admission to a healthcare service
.... id0..1stringUnique id for inter-element referencing
.... extension0..*ExtensionAdditional content defined by implementations
.... modifierExtension?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... dischargeDisposition0..1CodeableConceptCategory or kind of location after discharge
Binding: DischargeDisposition (example): Discharge Disposition.

... location0..*BackboneElementList of locations where the patient has been
.... id0..1stringUnique id for inter-element referencing
.... extension0..*ExtensionAdditional content defined by implementations
.... modifierExtension?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... location1..1Reference(Location)Location the encounter takes place

doco Documentation for this format

Detailed Definitions

Encounter

An interaction between a patient and healthcare provider(s) for the purpose of providing healthcare service(s) or assessing the health status of a patient.

Cardinality 0..*
Type Root

Encounter.id

The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

Cardinality 0..1
Type string
Comments The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

Encounter.meta

The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

Cardinality 0..1
Type Meta

Encounter.implicitRules

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

Cardinality 0..1
Type uri
Comments Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

Encounter.language

The base language in which the resource is written.

Cardinality 0..1
Type code Binding: CommonLanguages (preferred)
Comments Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

Encounter.text

A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

Cardinality 0..1
Type Narrative
Comments Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.

Encounter.contained

These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

Cardinality 0..*
Type Resource
Comments This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

Encounter.extension

An Extension

Cardinality 1..*
Type Extension

Encounter.extension:ahChartSharingGroup

An Extension used to reference a specific athenahealth chart sharing group Organization.

Cardinality 0..1
Type Extension(AthenaChartSharingGroup)

Encounter.extension:ahPractice

An Extension used to reference a specific athenahealth practice Organization.

Cardinality 1..1
Type Extension(AthenaPractice)

Encounter.modifierExtension

May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Cardinality 0..*
Type Extension
Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Requirements Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Encounter.identifier

Identifier(s) by which this encounter is known.

Cardinality 0..*
Type Identifier

Encounter.status

planned | arrived | triaged | in-progress | onleave | finished | cancelled +.

Cardinality 1..1
Type code Binding: EncounterStatus (required)
Comments Note that internal business rules will determine the appropriate transitions that may occur between statuses (and also classes).

Encounter.class

Concepts representing classification of patient encounter such as ambulatory (outpatient), inpatient, emergency, home health or others due to local variations.

Cardinality 1..1
Type Coding Binding: v3.ActEncounterCode (extensible)

Encounter.type

Specific type of encounter (e.g. e-mail consultation, surgical day-care, skilled nursing, rehabilitation).

Cardinality 0..*
Type CodeableConcept Binding: EncounterType (example)
Comments Since there are many ways to further classify encounters, this element is 0..*.

Encounter.subject

The patient present at the encounter

Cardinality 0..1
Type Reference(Patient)
Comments While the encounter is always about the patient, the patient might not actually be known in all contexts of use, and there may be a group of patients that could be anonymous (such as in a group therapy for Alcoholics Anonymous - where the recording of the encounter could be used for billing on the number of people/staff and not important to the context of the specific patients) or alternately in veterinary care a herd of sheep receiving treatment (where the animals are not individually tracked).

Encounter.participant

The list of people responsible for providing the service.

Cardinality 0..*
Type BackboneElement

Encounter.participant.id

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Cardinality 0..1
Type string

Encounter.participant.extension

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Cardinality 0..*
Type Extension
Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Encounter.participant.modifierExtension

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Cardinality 0..*
Type Extension
Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Requirements Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Encounter.participant.type

Role of participant in encounter.

Cardinality 0..*
Type CodeableConcept Binding: ParticipantType (extensible)
Comments The participant type indicates how an individual participates in an encounter. It includes non-practitioner participants, and for practitioners this is to describe the action type in the context of this encounter (e.g. Admitting Dr, Attending Dr, Translator, Consulting Dr). This is different to the practitioner roles which are functional roles, derived from terms of employment, education, licensing, etc.

Encounter.participant.period

The period of time that the specified participant participated in the encounter. These can overlap or be sub-sets of the overall encounter's period.

Cardinality 0..1
Type Period

Encounter.participant.individual

Persons involved in the encounter other than the patient.

Cardinality 0..1
Type Reference(Practitioner)

Encounter.period

The start and end time of the encounter.

Cardinality 0..1
Type Period
Comments If not (yet) known, the end of the Period may be omitted.

Encounter.reasonCode

Reason the encounter takes place, expressed as a code. For admissions, this can be used for a coded admission diagnosis.

Cardinality 0..*
Type CodeableConcept Binding: EncounterReasonCodes (preferred)
Comments For systems that need to know which was the primary diagnosis, these will be marked with the standard extension primaryDiagnosis (which is a sequence value rather than a flag, 1 = primary diagnosis).

Encounter.hospitalization

Details about the admission to a healthcare service.

Cardinality 0..1
Type BackboneElement
Comments An Encounter may cover more than just the inpatient stay. Contexts such as outpatients, community clinics, and aged care facilities are also included. The duration recorded in the period of this encounter covers the entire scope of this hospitalization record.

Encounter.hospitalization.id

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Cardinality 0..1
Type string

Encounter.hospitalization.extension

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Cardinality 0..*
Type Extension
Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Encounter.hospitalization.modifierExtension

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Cardinality 0..*
Type Extension
Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Requirements Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Encounter.hospitalization.dischargeDisposition

Category or kind of location after discharge.

Cardinality 0..1
Type CodeableConcept Binding: DischargeDisposition (example)

Encounter.location

List of locations where the patient has been during this encounter.

Cardinality 0..*
Type BackboneElement
Comments Virtual encounters can be recorded in the Encounter by specifying a location reference to a location of type "kind" such as "client's home" and an encounter.class = "virtual".

Encounter.location.id

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Cardinality 0..1
Type string

Encounter.location.extension

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Cardinality 0..*
Type Extension
Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Encounter.location.modifierExtension

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Cardinality 0..*
Type Extension
Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Requirements Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Encounter.location.location

The location where the encounter takes place.

Cardinality 1..1
Type Reference(Location)

Interactions

READ

Read interactions are executed as specified in the HL7 FHIR RESTful API read specification. To read Encounter resources, an application will perform an HTTP GET specifying the logical ID of the Encounter being retrieved.

The [patient|user|system]/Encounter.read authorization scope is required.

GET
/fhir/r4/Encounter/{logicalId}
Try in Postman

Parameters

❙ required

❙ conditional required

Name Type Description
logicalId string (REQUIRED) The logical ID of the resource (alias: Resource.id). It is specified in the URL path and not as a query parameter.

Response Codes

Response code Description
200 OK The requested Encounter resource was found and is contained within the body of the HTTP response.
400 Bad Request The server could not understand the request due to invalid syntax. The body of the HTTP response will contain an OperationOutcome resource that indicates the invalid request could not be processed.
404 Not Found The requested resource does not exist. The body of the HTTP response will contain an OperationOutcome resource that indicates the resource could not be found.
410 Gone The requested resource has been permanently deleted from server with no forwarding address. The body of the HTTP response will contain an OperationOutcome resource that indicates the resource could not be found.
500 Internal Server Error The server has encountered a situation it doesn't know how to handle. The body of the HTTP response will contain an OperationOutcome resource that indicates the nature of the error.
5xx Server Error The server may return other error codes to indicate other error conditions. The body of the HTTP response will contain an OperationOutcome resource that indicates the nature of the error.

GET SEARCH

Search interactions are executed as specified in the HL7 FHIR RESTful API search specification. To search for Encounter resources using the HTTP GET method, an application will perform the HTTP GET specifying the query parameters associated with the Encounter in the URL.

The [patient|user|system]/Encounter.read authorization scope is required.

The following additional authorization scopes might be required depending on _include and/or _revinclude search parameters used:

  • [patient|user|system]/Organization.read
  • [patient|user|system]/Patient.read
  • [patient|user|system]/Provenance.read

GET
/fhir/r4/Encounter
Try in Postman

Parameters

Encounter search requests conditionally require one of the following search parameters or search parameter combinations in order to match and return a result set:
  • patient
  • _id

❙ required

❙ conditional required

Name Type Description
ah-practice reference Identify the athenahealth Practice Organization (e.g., 'ah-practice=Organization/a-1.Practice-[practiceId]')
_id token (CONDITIONAL REQUIRED) Encounter.id resource reference to FHIR Encounter resource
patient reference (CONDITIONAL REQUIRED) Encounter.patient resource reference to FHIR Patient resource
date date Encounter.period resource reference to FHIR Period resource
_count number The number of Encounter resources to return per page for paged search results.
cursor token Search by cursor token for first resource to return in a paged search result
ah-chart-sharing-group reference Search by athenahealth Chart Sharing Group (e.g., 'ah-chart-sharing-group=Organization/a-[practiceId].CSG-[csgId]') for resources containing the 'Athena Chart Sharing Group' Extension
_include string Requests the server to include the referenced resource(s) in the search results according to the specified search parameter. Additional authorization scope(s) will be required. The supported _include parameter values are:
  • Encounter:ah-chart-sharing-group - Included resource(s) Organization and required scope(s) [patient|user|system]/Organization.read
  • Encounter:ah-practice - Included resource(s) Organization and required scope(s) [patient|user|system]/Organization.read
  • Encounter:patient - Included resource(s) Patient and required scope(s) [patient|user|system]/Patient.read
_revinclude string Requests the server to include the associated resource(s) in the search results according to the specified search parameter. Additional authorization scope(s) will be required. The supported _revinclude parameter values are:
  • Provenance:target - Associated resource(s) Provenance and required scope(s) [patient|user|system]/Provenance.read

Response Codes

Response code Description
200 OK The search request succeeded. The body of the HTTP response will contain a Bundle resource containing the results of the search.
403 Forbidden The server refused to perform the search due to a missing required search parameter. The body of the HTTP response will contain an OperationOutcome resource that includes the required search parameters.
500 Internal Server Error The server has encountered a situation it doesn't know how to handle. The body of the HTTP response will contain an OperationOutcome resource that indicates the nature of the error.
5xx Server Error The server may return other error codes to indicate other error conditions. The body of the HTTP response will contain an OperationOutcome resource that indicates the nature of the error.

POST SEARCH

Search interactions are executed as specified in the HL7 FHIR RESTful API search specification. To search for Encounter resources using the HTTP POST method, an application will perform the HTTP POST specifying the query parameters associated with the Encounter in the request body.

The [patient|user|system]/Encounter.read authorization scope is required.

The following additional authorization scopes might be required depending on _include and/or _revinclude search parameters used:

  • [patient|user|system]/Organization.read
  • [patient|user|system]/Patient.read
  • [patient|user|system]/Provenance.read

POST
/fhir/r4/Encounter/_search
Try in Postman

Request Header

Content-Type: application/x-www-form-urlencoded

Request Body

param1=value1&param2=value2...

Parameters

Encounter search requests conditionally require one of the following search parameters or search parameter combinations in order to match and return a result set:
  • patient
  • _id

❙ required

❙ conditional required

Name Type Description
ah-practice reference Identify the athenahealth Practice Organization (e.g., 'ah-practice=Organization/a-1.Practice-[practiceId]')
_id token (CONDITIONAL REQUIRED) Encounter.id resource reference to FHIR Encounter resource
patient reference (CONDITIONAL REQUIRED) Encounter.patient resource reference to FHIR Patient resource
date date Encounter.period resource reference to FHIR Period resource
_count number The number of Encounter resources to return per page for paged search results.
cursor token Search by cursor token for first resource to return in a paged search result
ah-chart-sharing-group reference Search by athenahealth Chart Sharing Group (e.g., 'ah-chart-sharing-group=Organization/a-[practiceId].CSG-[csgId]') for resources containing the 'Athena Chart Sharing Group' Extension
_include string Requests the server to include the referenced resource(s) in the search results according to the specified search parameter. Additional authorization scope(s) will be required. The supported _include parameter values are:
  • Encounter:ah-chart-sharing-group - Included resource(s) Organization and required scope(s) [patient|user|system]/Organization.read
  • Encounter:ah-practice - Included resource(s) Organization and required scope(s) [patient|user|system]/Organization.read
  • Encounter:patient - Included resource(s) Patient and required scope(s) [patient|user|system]/Patient.read
_revinclude string Requests the server to include the associated resource(s) in the search results according to the specified search parameter. Additional authorization scope(s) will be required. The supported _revinclude parameter values are:
  • Provenance:target - Associated resource(s) Provenance and required scope(s) [patient|user|system]/Provenance.read

Response Codes

Response code Description
200 OK The search request succeeded. The body of the HTTP response will contain a Bundle resource containing the results of the search.
403 Forbidden The server refused to perform the search due to a missing required search parameter. The body of the HTTP response will contain an OperationOutcome resource that includes the required search parameters.
500 Internal Server Error The server has encountered a situation it doesn't know how to handle. The body of the HTTP response will contain an OperationOutcome resource that indicates the nature of the error.
5xx Server Error The server may return other error codes to indicate other error conditions. The body of the HTTP response will contain an OperationOutcome resource that indicates the nature of the error.
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